THE « PEAK PALU » IS COMING…

9651km from home (Ottawa,ON)

Another week gone by. Time has gone a lot faster these last few days. I am busy with my various tasks and my adaptation to the climate, the people, and the project. This remains a positive experience. I don’t regret my decision to participate in a MSF project – I can finally see what kind of impact the organisation can have on the population.

Entrance to Boguila Hospital

I work at the Boguila hospital as the manager of the Intensive Care Unit (ICU), the emergency department and the In-Patient Department (IPD) – pediatric ward, and medicine/surgery ward.  This is quite the challenge for me! I don’t think I ever had that many responsibilities in my nursing career. But I feel ready and motivated. The team of nurses and “secouristes” works well and the mood is good despite the difficulties present in the country and the area. This is encouraging because the rainy season will arrive very soon and this is our busiest time of the year – malaria season or the « Peak Palu » as it is called here.

Already, our Out-Patient Department (OPD) has seen the number of cases increase daily.  And most of our admitted patients – with a great number of children under five years – suffer from the severe form of the illness.

Malaria (or « paludisme » in French), a parasitic infection, is transmitted to humans by the bite of a mosquito. Most of the infections are due to four species: P.Falciparum, P.Vivax, P.Ovale and P.Malariae. In our region, we mainly see infections caused by the first species – Plasmodium Falciparum. Unfortunately, this species often causes complications, thus the name Severe Malaria.

The clinical signs of uncomplicated malaria include a fever associated with chills, sweating, headache, muscle pain, a lack of appetite and nausea. In children, these symptoms also include abdominal pain, diarrhoea and vomiting.  Children and pregnant women can also often suffer from anaemia. If it is unfortunately a severe malaria case, the patient can present with changes in his level of consciousness (delirium, coma), convulsions, extreme weakness, respiratory distress, shock, renal failure.

After our clinical assessment, we quickly confirm our suspicion of malaria with a Rapid Diagnostic Test (RDT) called ParaCheck. A few drops of blood are required for this quick test. Of note, in the event we do not have the RDT, the treatment of a suspect malaria case should not be delayed because an individual suffering from uncomplicated malaria can rapidly progress to severe malaria, which can cause death within a few hours if untreated.  No time to lose!

Treatment is relatively simple – artemisinin-based tablets for three days. A coformulation (2 antimalarials in one tablet) is preferred as treatment. In hour hospital, we are using the coformulation Artemether/Lumefantrine (CoArtem). In the event of vomiting which prevents an oral treatment, we can also use an intravenous intramuscular treatment - Artesunate. As for the other symptoms such as anaemia, fever or hypoglycaemia, we treat them individually, as they present.

Village House

We try to encourage the population to protect themselves during the rainy season with mosquito bed nets. All of our admitted patients, regardless of their diagnostic, are given a mosquito bed net for the duration of their stay in the hospital. All admitted children leave the hospital with their own mosquito bed net. Despite our efforts, the population does not use the bed nets on a daily basis, complaining that the combination of the heat and the bed net during the night prevents them from sleeping well. In addition, the lack of money and resources, and big families limit the purchase of bed nets for all the members of the same family. This explains the high rate of malaria in children – the parents keep the bed net for themselves or for a baby sleeping with them.

The last month having left its mark in CAR with a successful military coup and increasing insecurity amongst the population, we see many people staying in the bush with their family. A large number have not yet returned to their village for fear of retaliation, looting or injuries.  So they continue to live in the forest, without food, without drinking water and without protection. One of the consequences of this exile will be an increased number of malaria cases, and an even greater number of death due to the illness as the population has no immediate means to health care. When they decide to come to the hospital, it might be too late to receive treatment in time. All we can hope for now is to pass on the message through discharged patients that we are present and that we offer free health care.

Until next week…

Janique.